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1.
PLoS Biol ; 18(3): e3000645, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32134916

RESUMO

Understanding the genetic basis of variation in life span is a major challenge that is difficult to address in human populations. Evolutionary theory predicts that alleles affecting natural variation in life span will have properties that enable them to persist in populations at intermediate frequencies, such as late-life-specific deleterious effects, antagonistic pleiotropic effects on early and late-age fitness components, and/or sex- and environment-specific or antagonistic effects. Here, we quantified variation in life span in males and females reared in 3 thermal environments for the sequenced, inbred lines of the Drosophila melanogaster Genetic Reference Panel (DGRP) and an advanced intercross outbred population derived from a subset of DGRP lines. Quantitative genetic analyses of life span and the micro-environmental variance of life span in the DGRP revealed significant genetic variance for both traits within each sex and environment, as well as significant genotype-by-sex interaction (GSI) and genotype-by-environment interaction (GEI). Genome-wide association (GWA) mapping in both populations implicates over 2,000 candidate genes with sex- and environment-specific or antagonistic pleiotropic allelic effects. Over 1,000 of these genes are associated with variation in life span in other D. melanogaster populations. We functionally assessed the effects of 15 candidate genes using RNA interference (RNAi): all affected life span and/or micro-environmental variance of life span in at least one sex and environment and exhibited sex-and environment-specific effects. Our results implicate novel candidate genes affecting life span and suggest that variation for life span may be maintained by variable allelic effects in heterogeneous environments.


Assuntos
Proteínas de Drosophila/genética , Drosophila melanogaster/fisiologia , Longevidade/genética , Animais , Drosophila melanogaster/genética , Feminino , Interação Gene-Ambiente , Variação Genética , Estudo de Associação Genômica Ampla , Masculino , Interferência de RNA , Temperatura
2.
Ann Intern Med ; 172(2): 134-142, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31905376

RESUMO

Background: Before Canada's single-payer reform, its payment system, health costs, and number of health administrative personnel per capita resembled those of the United States. By 1999, administration accounted for 31% of U.S. health expenditures versus 16.7% in Canada. No recent comprehensive analyses of those costs are available. Objective: To quantify 2017 spending for administration by insurers and providers. Design: Analyses of government reports, accounting data that providers file with regulators, surveys of physicians, and census-collected data on employment in health care. Setting: United States and Canada. Measurements: Insurance overhead; administrative expenditures of hospitals, physicians, nursing homes, home care agencies, and hospices. Results: U.S. insurers and providers spent $812 billion on administration, amounting to $2497 per capita (34.2% of national health expenditures) versus $551 per capita (17.0%) in Canada: $844 versus $146 on insurers' overhead; $933 versus $196 for hospital administration; $255 versus $123 for nursing home, home care, and hospice administration; and $465 versus $87 for physicians' insurance-related costs. Of the 3.2-percentage point increase in administration's share of U.S. health expenditures since 1999, 2.4 percentage points was due to growth in private insurers' overhead, mostly because of high overhead in their Medicare and Medicaid managed-care plans. Limitations: Estimates exclude dentists, pharmacies, and some other providers; accounting categories for the 2 countries differ somewhat; and methodological changes probably resulted in an underestimate of administrative cost growth since 1999. Conclusion: The gap in health administrative spending between the United States and Canada is large and widening, and it apparently reflects the inefficiencies of the U.S. private insurance-based, multipayer system. The prices that U.S. medical providers charge incorporate a hidden surcharge to cover their costly administrative burden. Primary Funding Source: None.


Assuntos
Pessoal Administrativo/economia , Atenção à Saúde/economia , Canadá , Serviços de Assistência Domiciliar/economia , Cuidados Paliativos na Terminalidade da Vida/economia , Administração Hospitalar/economia , Humanos , Casas de Saúde/economia , Estados Unidos
3.
J Avian Med Surg ; 34(2): 192-197, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32702960

RESUMO

A captive, 22-year-old, intact male Sunda wrinkled hornbill (Aceros corrugatus) was presented for an acute onset of open-mouth breathing and bilaterally drooped wings. An external physical examination revealed a moderately thin body condition, marked respiratory effort, and a significant heart murmur. Diagnostic blood testing revealed moderate azotemia and persistent erythrocytosis, initially documented 2 years before this event. Radiographic imaging revealed a subjectively enlarged heart and a right dorsal coelomic cavity mass. Further diagnostic testing included an echocardiogram and ultrasound-guided fine-needle aspirate of the right coelomic cavity mass, with cytology consistent with a carcinoma. The bird was euthanatized because of the poor prognosis. Necropsy and histopathology identified right atrioventricular valve hypertrophy with severe hypertrophic and dilated cardiomyopathy of the right ventricular free wall, atherosclerosis of the great vessels and arteriosclerosis of myocardial vessels, severe hepatic extramedullary hematopoiesis, and pulmonary carcinoma of the right lung. In this case, erythrocytosis was considered a physiologic response to hypoxemia caused by the lung mass.


Assuntos
Doenças das Aves/diagnóstico , Policitemia/veterinária , Animais , Animais de Zoológico , Doenças das Aves/sangue , Aves , Carcinoma/complicações , Carcinoma/diagnóstico , Carcinoma/veterinária , Diagnóstico Diferencial , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/veterinária , Masculino , Policitemia/complicações , Policitemia/diagnóstico
4.
J Zoo Wildl Med ; 49(4): 952-958, 2018 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-30592916

RESUMO

Iodine is an essential micronutrient for elasmobranchs in order to prevent goiter. Preventing goiter requires bioavailable iodide: either oral iodide or maintaining adequate aquarium water iodide concentrations. The objective of this study was to determine how oral and water supplementation affected iodine (I2) and iodide (I-) concentrations in artificial seawater aquaria housing captive white-spotted bamboo sharks ( Chiloscyllium plagiosum). Daily water samples were collected and free iodine (I2) was determined using ultraviolet-absorbance spectrophotometry (a relatively simple in-house assay) and total iodide (I-) via liquid chromatography (a more time- and expertise-intense quantification method) to learn the effects of supplementation. One water system received iodine and iodide supplementation in the form of 5% Lugol's iodine solution added directly to the water, while a second water system received no supplementation. In addition, one tank of sharks in each water system received oral iodide supplementation. Results indicated that oral supplementation provides greater increases in water concentrations of bioavailable iodide (I-) than direct water supplementation. In addition, the chromatographic results suggested that iodide is present in higher concentrations in the systems not receiving water supplementation. Increased iodide concentrations were detected in water samples after water changes and after oral iodide supplementation was administered, but total iodine (I2) concentration changes were not detectable within the same time frame.


Assuntos
Cromatografia Líquida/veterinária , Iodo/análise , Água do Mar/análise , Tubarões/metabolismo , Espectrofotometria Ultravioleta/veterinária , Oligoelementos/análise , Animais , Animais de Zoológico/metabolismo , Cromatografia Líquida/métodos , Colorado , Feminino , Iodetos/análise , Masculino , Espectrofotometria Ultravioleta/métodos
5.
Zoo Biol ; 36(4): 284-288, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28643409

RESUMO

Elasmobranch hematology continues to reveal new peculiarities within this specialized field. This report compares total hematologic values from the same white-spotted bamboo sharks (Chiloscyllium plagiosum) housed in different environments. We compared the hemograms one year apart, using a standardized Natt-Herrick's technique. The total white blood cell (WBC) counts of the sharks were statistically different between the two time points (initial median total WBC count = 18,920 leukocytes/µl, SD = 8,108; 1 year later total WBC count = 1,815 leukocytes/µl, SD = 1,309). The packed cell volumes were additionally found to be statistically different (19%, SD = 2.9 vs. 22%, SD = 2.0). Analysis revealed the only differences between the time points were the temperature and stocking densities at which these sharks were housed. This report emphasizes the need for a thorough understanding of the husbandry of an elasmobranch prior to interpretation of a hemogram and suggests that reference intervals should be created for each environment.


Assuntos
Abrigo para Animais , Tubarões/sangue , Adaptação Fisiológica , Animais , Feminino , Contagem de Leucócitos/veterinária , Masculino , Fatores Sexuais , Tubarões/fisiologia , Temperatura
6.
Zoo Biol ; 35(3): 251-9, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26970476

RESUMO

As elasmobranch medicine becomes more commonplace, there continues to be confusion with techniques and evaluation of the shark hemogram and it remains unknown if they are able to mount an inflammatory hemic response. The aims of this study were to compare two total white blood cell (WBC) count techniques, establish a reference interval for captive white-spotted bamboo sharks (Chiloscyllium plagiosum), and determine if elasmobranchs are capable of mounting an inflammatory hemic response. Correlation statistics were performed on hematologic results for healthy female bamboo sharks to assess the use of Natt-Herrick's and phloxine methods. Total WBC counts and differentials were obtained from males with severe traumatic clasper wounds and compared to the healthy females. We elected clasper amputation as the preferred treatment intervention and post-operative hematology was performed one month later. There was poor correlation of leukocyte counts between the two WBC count methods. Hematologic values were established for the females and males pre- and post-operatively. Males with wounds had a marked leukocytosis and heterophilia. Post-operative blood work showed a resolution of total WBC count and a trend toward resolution of the heterophilia. This study provides hematologic values for white-spotted bamboo sharks and confirms that the Natt-Herrick's method is preferred for lymphocytic species. Hematologic differences present in males with clasper wounds suggests that elasmobranchs do mount an inflammatory hemic response. Treatment via clasper amputation proved to be a safe and efficient means for clinical treatment that led to a trend toward resolution of the inflammatory leukogram. Zoo Biol. 35:251-259, 2016. © 2016 Wiley Periodicals, Inc.


Assuntos
Animais de Zoológico/fisiologia , Inflamação/veterinária , Contagem de Leucócitos/veterinária , Tubarões/fisiologia , Animais , Feminino , Doenças dos Peixes/sangue , Doenças dos Peixes/patologia , Doenças dos Peixes/cirurgia , Inflamação/sangue , Inflamação/patologia , Inflamação/cirurgia , Masculino , Valores de Referência , Reprodutibilidade dos Testes
7.
PLoS Genet ; 8(3): e1002593, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22479193

RESUMO

Phenotypic plasticity is the ability of a single genotype to produce different phenotypes in response to changing environments. We assessed variation in genome-wide gene expression and four fitness-related phenotypes of an outbred Drosophila melanogaster population under 20 different physiological, social, nutritional, chemical, and physical environments; and we compared the phenotypically plastic transcripts to genetically variable transcripts in a single environment. The environmentally sensitive transcriptome consists of two transcript categories, which comprise ∼15% of expressed transcripts. Class I transcripts are genetically variable and associated with detoxification, metabolism, proteolysis, heat shock proteins, and transcriptional regulation. Class II transcripts have low genetic variance and show sexually dimorphic expression enriched for reproductive functions. Clustering analysis of Class I transcripts reveals a fragmented modular organization and distinct environmentally responsive transcriptional signatures for the four fitness-related traits. Our analysis suggests that a restricted environmentally responsive segment of the transcriptome preserves the balance between phenotypic plasticity and environmental canalization.


Assuntos
Drosophila melanogaster , Interação Gene-Ambiente , Aptidão Genética , Transcriptoma , Animais , Análise por Conglomerados , Drosophila melanogaster/genética , Drosophila melanogaster/fisiologia , Regulação da Expressão Gênica , Genoma de Inseto , Fenótipo
8.
Am Heart J ; 167(1): 28-35, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24332139

RESUMO

BACKGROUND: Guidelines for management of hypertension and lipids recommend using cardiovascular absolute risk (CVAR) to manage patients. This randomized controlled trial investigated the impact of CVAR assessment in family practice on management of cardiovascular risk, including prescription of antihypertensive and lipid-lowering medication. METHODS: A cluster randomized controlled trial was conducted from 2008 to 2010 in Sydney, Australia. Family practices were randomized, and patients aged 45 to 69 years were invited to participate. Intervention family physicians (FP) were trained in use of CVAR, provided with an electronic CVAR calculator, and assessed their patients' absolute risk in a dedicated consultation. Control practice patients received a general health check. Primary outcome analyzed was the proportion of patients in each group on antihypertensive and/or lipid-lowering medication at 12 months. Multilevel logistic regression was performed to explore variables influencing changes in pharmacologic therapy. RESULTS: The study recruited 36 FPs from 34 practices and 1,074 patients, of which 906 (84.4%) completed 12-month follow-up. At 12 months, there was no significant difference between the intervention and control groups in proportion of patients on antihypertensives (31.2% vs 34.3%, P = .31), but control group patients were more likely to be on lipid-lowering medications (30.2% vs 22.7%, P = .01). After multilevel analysis, this difference was not present. Intensification or reduction of pharmacologic therapy was associated with meeting treatment targets for blood pressure and lipids but not with the CVAR or intervention group. CONCLUSIONS: Single-risk factor management remains a strong influence on FP prescribing practices. Shifting to an approach based on CVAR will require more intensive intervention.


Assuntos
Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Hipolipemiantes/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medição de Risco
9.
Zoo Biol ; 32(1): 104-11, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22588699

RESUMO

Southern stingrays, Dasyatis americana, are a well-represented elasmobranch species in public aquaria and other facilities throughout the world. This study was conducted at a facility that experienced some mortality and replenished the collection with wild-caught stingrays. A common necropsy finding among the stingrays was a small, dark liver. The objectives of this study were to assess the reliability of an ultrasound-guided technique for establishing a liver-to-coelom ratio by calculating the approximate length of the liver with respect to the coelomic cavity length and then to compare ratios between acclimated captive and wild-caught stingrays. The ultrasound validation phase of the study measured the distance from the caudal margin of the liver to the pelvic cartilaginous girdle and compared it to the actual distance measured during the necropsy or surgery. There was no significant difference found between the ultrasound and actual distance measurements (P = 0.945). This technique was then used to establish liver-to-coelom ratios and compare two groups of stingrays, presumably under different metabolic states at different periods. Liver-to-coelom ratios were established during initial examinations as well as 8 months after cohabitation in a touch pool exhibit. There were significant differences in liver-to-coelom ratios between the two stingray groups at introduction (median difference = 30.9%, P = 0.007) and after 8 months (median difference = 20.5%, P = 0.008). There were also significant differences in the liver-to-coelom ratios within each group at introduction and at 8 months (acclimated group median difference = 20.4%, P = 0.018; wild-caught group median difference 31%, P = 0.008).


Assuntos
Anatomia Comparada/métodos , Animais Selvagens , Animais de Zoológico , Elasmobrânquios/anatomia & histologia , Fígado/anatomia & histologia , Ultrassonografia/normas , Animais , Pesos e Medidas Corporais , Fígado/diagnóstico por imagem , Tamanho do Órgão/fisiologia , Estatísticas não Paramétricas , Ultrassonografia/métodos
10.
Scientometrics ; 128(6): 3225-3255, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36818051

RESUMO

This paper uses accounting concepts-particularly the concept of Return on Investment (ROI)-to reveal the quantitative value of scientific research pertaining to a major US cyberinfrastructure project (XSEDE-the eXtreme Science and Engineering Discovery Environment). XSEDE provides operational and support services for advanced information technology systems, cloud systems, and supercomputers supporting non-classified US research, with an average budget for XSEDE of US$20M+ per year over the period studied (2014-2021). To assess the financial effectiveness of these services, we calculated a proxy for ROI, and converted quantitative measures of XSEDE service delivery into financial values using costs for service from the US marketplace. We calculated two estimates of ROI: a Conservative Estimate, functioning as a lower bound and using publicly available data for a lower valuation of XSEDE services; and a Best Available Estimate, functioning as a more accurate estimate, but using some unpublished valuation data. Using the largest dataset assembled for analysis of ROI for a cyberinfrastructure project, we found a Conservative Estimate of ROI of 1.87, and a Best Available Estimate of ROI of 3.24. Through accounting methods, we show that XSEDE services offer excellent value to the US government, that the services offered uniquely by XSEDE (that is, not otherwise available for purchase) were the most valuable to the facilitation of US research activities, and that accounting-based concepts hold great value for understanding the mechanisms of scientific research generally.

11.
Health Policy ; 125(3): 327-334, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33402264

RESUMO

BACKGROUND: In the past decade many novel, and in some cases transformative, cancer medicines have entered the market. Their prices and the amount spent on them by governments have increased rapidly, bringing to the forefront trade-offs that must be made. In this paper we explore the Australian public's attitude towards the funding of high cost cancer medicines (HCCM) to inform reimbursement and health technology assessment (HTA) policy. METHODS: A survey consisting of 49 questions about the funding of HCCMs was developed by the investigators. Recruitment was conducted via Qualtrics. 1039 Australian adults completed the survey. RESULTS: The Australian public overwhelmingly supports funding of HCCMs (95.5 %) to enhance equity of access (97.8 %), and to respond to patients' needs (98 %). When respondents were challenged to balance equity versus access in different contexts inconsistencies emerged. Different demographic factors were important in predicting support for various strategies. CONCLUSION: Our results suggest that the Australian public strongly supports government funding of HCCMs and values both equity and access. Equally, however, the public is uncertain about how equity and access are to be balanced and achieved, and such ambivalence needs to be both further explored and accommodated in policy processes. Our results may be used by policymakers in Australia, and countries with similar systems and values, to further develop policies and processes for funding HCCMs.


Assuntos
Custos de Medicamentos , Neoplasias , Adulto , Atitude , Austrália , Humanos , Neoplasias/tratamento farmacológico , Inquéritos e Questionários
12.
Vet Ophthalmol ; 13 Suppl: 123-7, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20840101

RESUMO

This report describes a long-horned cowfish, which was diagnosed with buphthalmia and lens sub-luxation in the right eye, conditions that progressed to complete anterior lens luxation and secondary keratoconus. Three months after the initial evaluation, a pigmented mass was observed protruding from the vitreous. An enucleation was performed under general anesthesia. Ocular histopathology revealed an iridociliary melanoma. Reports of intraocular melanomas are extremely rare in fish. To the authors' knowledge, this is the first report of an iridociliary melanoma that led to buphthalmia, lens luxation, and keratoconus in a fish. Histological findings of lens luxation are also demonstrated. Due to the presence of a complex suspensory apparatus involving the teleost lens, this report speculates that lens luxation is a more devastating disease process in teleosts than in mammals.


Assuntos
Neoplasias Oculares/veterinária , Doenças dos Peixes/patologia , Melanoma/veterinária , Tetraodontiformes , Animais , Neoplasias Oculares/patologia , Neoplasias Oculares/cirurgia , Doenças dos Peixes/cirurgia , Masculino , Melanoma/patologia , Melanoma/cirurgia
13.
Aust Fam Physician ; 39(12): 954-8, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21301679

RESUMO

Despite a decline in recent decades, cardiovascular disease (CVD) remains the major cause of death and disability in Australia. To improve primary prevention of CVD, many clinical guidelines recommend using cardiovascular absolute risk (CVAR) assessment to guide risk factor management. Cardiovascular absolute risk assessment predicts the overall risk of a cardiovascular event over a given time period (usually 5 or 10 years). However, use of CVAR is limited and has not been incorporated well in routine general practice. There has been little research on CVAR implementation and an effective implementation strategy has been lacking.


Assuntos
Doenças Cardiovasculares/etiologia , Medicina Geral , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , New South Wales/epidemiologia , Prevenção Primária , Medição de Risco
14.
Am Heart J ; 157(3): 436-41, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19249412

RESUMO

BACKGROUND: Although cardiovascular absolute risk (CVAR) assessment has been recommended for use in Australian general practice for a number of years, there is continuing uncertainty about its implementation and impact. Our previous work has developed a multifaceted implementation model. This study aims to investigate both the feasibility of using this model and the impact of CVAR assessment and management on general practice clinical processes and patient care. STUDY DESIGN: This cluster randomized controlled trial will be conducted in general practices in Sydney, involving general practitioners (GPs), other practice staff, and patients aged 45 to 69 years without existing cardiovascular disease. METHODS: A total of 32 practices (40 GPs) and 1,320 patients will be recruited. Randomization will be conducted at the practice level. The intervention group of GPs will be trained to use a CVAR implementation model, whereas the control group of GPs will continue usual care. Study outcomes include clinical processes, patient risk, use of lifestyle intervention, and prescription of antihypertensive and lipid-lowering medications. Data will be collected and analyzed using mixed methods. Study outcomes before and after the intervention will be compared, and the 2 groups will also be compared after adjusting for baseline difference and clustering factors. DISCUSSION: This trial will be the first study in Australian general practice and one of few international studies to evaluate the impact of implementing CVAR assessment and management. Results of this study will help improve the primary prevention of cardiovascular disease and inform guidelines for clinical practice and the implementation of other health initiatives.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Medicina de Família e Comunidade , Austrália , Gerenciamento Clínico , Estudos de Viabilidade , Comportamentos Relacionados com a Saúde , Humanos , Avaliação de Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto , Projetos de Pesquisa , Medição de Risco
15.
J Am Vet Med Assoc ; 234(8): 1055-9, 2009 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-19366339

RESUMO

CASE DESCRIPTION: A 20-year-old sexually intact female African Grey parrot (Psittacus erithacus) was evaluated to determine the cause of lethargy, hyporexia, weight loss, and persistent ascites of 21 days' duration. CLINICAL FINDINGS: Physical examination revealed a markedly distended abdomen and systolic heart murmur. Thoracic radiography revealed cardiomegaly and hepatomegaly. Doppler echocardiography revealed severe eccentric and concentric hypertrophy of the right ventricle with systolic dysfunction, moderate regurgitation through the right atrioventricular valve, a substantial increase in estimated systolic pulmonary arterial pressure, hepatic venous congestion, and coelomic effusion. A clinical diagnosis of chronic cor pulmonale was established. TREATMENT AND OUTCOME: The parrot was initially stabilized by use of coelomocentesis. During the next month, the parrot was treated by administration of furosemide, hydrochlorothiazide, spironolactone, benazepril, and pimobendan. The parrot appeared to be responding well to treatment but was found dead in its cage 35 days following initial examination. Postmortem examination revealed substantial atherosclerosis of the large pulmonary arteries, with lesions extending into the medium-size arteries. Pulmonary atherosclerosis was suspected as a cause of the severe pulmonary hypertension. CLINICAL RELEVANCE: Although atherosclerosis most commonly affects the systemic and coronary arteries of parrots, sclerotic changes within the pulmonary vasculature should be considered as a possible cause of pulmonary hypertension and as a differential diagnosis for right-sided congestive heart failure in psittacine species.


Assuntos
Aterosclerose/veterinária , Doenças das Aves/etiologia , Pneumopatias/veterinária , Papagaios , Artéria Pulmonar/patologia , Doença Cardiopulmonar/veterinária , Animais , Aterosclerose/complicações , Aterosclerose/diagnóstico , Doenças das Aves/diagnóstico , Doenças das Aves/terapia , Doença Crônica , Diagnóstico Diferencial , Ecocardiografia Doppler/veterinária , Ecocardiografia Doppler em Cores/veterinária , Evolução Fatal , Feminino , Pneumopatias/complicações , Pneumopatias/diagnóstico , Paracentese/veterinária , Doença Cardiopulmonar/diagnóstico , Doença Cardiopulmonar/etiologia , Doença Cardiopulmonar/terapia
16.
J Am Vet Med Assoc ; 232(9): 1338-43, 2008 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-18447778

RESUMO

OBJECTIVE: To determine the long-term survival rate and factors that affect survival time of domestic ferrets treated surgically for hyperadrenocorticism. STUDY DESIGN: Retrospective case series. ANIMALS: 130 ferrets with hyperadrenocorticism that were treated surgically. PROCEDURES: Medical records of ferrets surgically treated for hyperadrenocorticism were reviewed. Data recorded included signalment, duration of clinical signs prior to hospital admission, CBC values, serum biochemical analysis results, anesthetic time, surgical time, concurrent diseases, adrenal gland affected (right, left, or both [bilateral]), histopathologic diagnosis, surgical procedure, caudal vena caval involvement (yes or no), postoperative melena (yes or no), days in hospital after surgery, and whether clinical signs of hyperadrenocorticism developed after surgery. RESULTS: 130 ferrets were entered in the study (11 of 130 ferrets were admitted and underwent surgery twice). The 1- and 2-year survival rates were 98% and 88%, respectively. A 50% survival rate was never reached. Combined partial adrenal gland resection with cryosurgery had a significantly negative effect on survival time. No other risk factors were identified. Survival time was not significantly affected by either histopathologic diagnosis or specific affected adrenal gland (right, left, or bilateral). CONCLUSIONS AND CLINICAL RELEVANCE: Ferrets with adrenal gland masses that were treated surgically had a good prognosis. Survival time of ferrets with hyperadrenocorticism undergoing surgery was not affected by the histologic characteristic of the tumor, the adrenal glands affected (right, left, or bilateral), or complete versus partial adrenal gland resection. Debulking was a sufficient surgical technique to allow a favorable long-term outcome when complete excision was not possible.


Assuntos
Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adrenalectomia/veterinária , Hiperfunção Adrenocortical/veterinária , Furões , Hiperfunção Adrenocortical/cirurgia , Animais , Feminino , Masculino , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
17.
N Engl J Med ; 349(8): 768-75, 2003 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-12930930

RESUMO

BACKGROUND: A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs. METHODS: For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars. RESULTS: In 1999, health administration costs totaled at least 294.3 billion dollars in the United States, or 1,059 dollars per capita, as compared with 307 dollars per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada. Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.) CONCLUSIONS: The gap between U.S. and Canadian spending on health care administration has grown to 752 dollars per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.


Assuntos
Atenção à Saúde/organização & administração , Custos de Cuidados de Saúde/estatística & dados numéricos , Administração de Serviços de Saúde/economia , Seguro Saúde/economia , Programas Nacionais de Saúde/economia , Canadá , Atenção à Saúde/economia , Custos de Saúde para o Empregador/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Agências de Assistência Domiciliar/economia , Agências de Assistência Domiciliar/organização & administração , Casas de Saúde/economia , Casas de Saúde/organização & administração , Gerenciamento da Prática Profissional/economia , Gerenciamento da Prática Profissional/organização & administração , Estados Unidos
18.
Vet Clin North Am Exot Anim Pract ; 10(1): 1-24, v, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17198957

RESUMO

Cytology as a diagnostic tool has played a major role in the management of diseases affecting domestic mammals for over 20 years. It has also become a valuable diagnostic tool in the evaluation of nondomestic or the so-called "exotic" animal patients, such as small mammals and the lower vertebrates. Common cytologic specimens used to evaluate the exotic animal patient include aspirates of masses and organs, imprints of biopsy material, tracheal wash samples, aspiration of abdominal or coelomic fluid, and fecal smears. In general, the same cytologic sample collection and preparation techniques used for domestic mammals also apply to exotic animal patients. The interpretation of the cytology specimen is generally the same as that of domestic mammals.


Assuntos
Doenças dos Animais/patologia , Células/patologia , Citodiagnóstico/veterinária , Inflamação/veterinária , Neoplasias/veterinária , Animais , Células/citologia , Citodiagnóstico/métodos , Inflamação/patologia , Neoplasias/patologia
19.
J Zoo Wildl Med ; 38(2): 201-16, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17679503

RESUMO

Complete physical examinations and biomedical sample collection were performed on 70 free-ranging ring-tailed lemurs (Lemur catta) from three different habitats in the Beza Mahfaly Special Reserve (BMSR), in southern Madagascar, to assess the impact of humans and habitat on lemur health. Lemurs were chemically immobilized with ketamine and diazepam administered via blow darts for concurrent biomedical, morphometric, and behavioral studies. Subsets of the animals had blood analyzed for hematology, serum chemistry, micronutrients, fat-soluble vitamins (vitamins A, D, and E), measures of iron metabolism, and polymerase chain reaction assays (PCR) for Toxoplasma gondii, Hemoplasma spp., Bartonella spp., Ehrlichia spp., Anaplasma phagocytophilum, and Neorickettsia risticii. Results were compared on the basis of gender and the habitats at the study site: reserve (intact gallery forest), degraded (human inhabited and altered), and marginal (dry didieracea forest with heavy grazing and tree cutting). Levels of vitamin D, triglycerides, and cholesterol, and measures of iron metabolism for BMSR lemurs were greater than those previously reported for a free-ranging lemur population (Tsimanampetsotsa Strict Nature Reserve, Madagascar) with less access to foods of anthropogenic origin. BMSR ring-tailed lemurs from a habitat with less water (marginal) had higher sodium (P = 0.051), chloride (P = 0.045), osmolality (P = 0.010), and amylase (P = 0.05) levels than lemurs from other BMSR habitats, suggesting that these lemurs were less hydrated. Vitamin D levels of male lemurs were higher (P = 0.011) than those of females at BMSR, possibly because of differences in sunning behavior or differential selection of food items. The biological significance is uncertain for other parameters with statistically significant differences. All samples tested (n = 20) were negative for the pathogens tested using PCR assays. Continued concurrent biomedical and ecological research is needed at BMSR to confirm these results and determine their association with population mortality and fecundity rates.


Assuntos
Análise Química do Sangue/veterinária , Lemur , Estado Nutricional , Exame Físico/veterinária , Animais , Animais Selvagens , Bactérias/isolamento & purificação , Conservação dos Recursos Naturais , Feminino , Testes Hematológicos/veterinária , Lemur/microbiologia , Lemur/parasitologia , Lemur/fisiologia , Madagáscar , Masculino , Doenças Parasitárias em Animais/epidemiologia , Valores de Referência , Fatores Sexuais
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